Provider Demographics
NPI:1891389789
Name:CALIFORNIA SENIOR CARE
Entity Type:Organization
Organization Name:CALIFORNIA SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONY
Authorized Official - Middle Name:N
Authorized Official - Last Name:VANBANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-666-5116
Mailing Address - Street 1:3929 W 5TH ST
Mailing Address - Street 2:SP 100
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703
Mailing Address - Country:US
Mailing Address - Phone:714-251-4484
Mailing Address - Fax:303-954-9531
Practice Address - Street 1:3929 W 5TH ST
Practice Address - Street 2:SP 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703
Practice Address - Country:US
Practice Address - Phone:714-251-4484
Practice Address - Fax:303-954-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care